Application for Employment

Position applied for:

Date available for employment:

Available to work shifts, including nights:

Yes

Full name:

Address:

Post code:

Home phone:

Mobile phone:

Birthday:

Day

Month

Year

Ethnic origin:

Driving licence:

Provisional

Full

Current endorsements:

Criminal record:

Do you have any convictions, cautions, reprimands or final warnings that are not “protected” as defined by The Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013). If you do please list above.

Do you, or have you ever, had a family member working for The Old Rectory Care Home?

Yes

Right to work in the UK:

Are you applying for employment under a permit to work in the UK? If so, Please supply details above. (Date of permit, Expiry number, Permit number)

References

Please give the details of 2 referees - one MUST be your last employer:

Company name

Address

Phone